89129A - Copeland, William and Ladonna

�Atw?" ❑CAMA ❑ DREDGE & FILL NO 89129 A B C D
a . Previous permit
A.GENERAL PERMIT
Date previous permit issued
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMAsules
Applicant Name Authorized Agentl, ., c
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s)
Phone # ( )
Email '0i : i o I Subdivision
City ,.iC ZIP
'1
Affected ❑ CW ❑ EW ❑ PTA ❑ Es ❑ PTS Adj. Wtr. Body Cnat/man/unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj. Wtr. Body .�
ORW: yes�PNA: yes/no
Type of Project/ Activity
(Scale: Li.(. `, )
Shoreline Length.
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/q
Bulkhead/ Riprap length
Avg distance offshore _
Breakwater/Sill
Max distance/ length _
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boat
Beach Bulldozing
Other
SAV observed:
yes no
Moratorium: n/a
yes noi-+L�
Site Photos:
yes no
-- --t
Riparian Waiver Attached:
yes no
A building permit/zoning permit may be required by:
Permit Conditions
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) A
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
1.
Signature "Please read compliance statement on back of permit" Signature
Application Fee(s) Check#/Money Order Issuing Date ' Expiration Date

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CEGEIVED
S.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM APR 1 6 2024
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner Or their ageti 1
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Name of Property Owner -
Address of Property_
rol
Mailing Address of Owner. 1 wv N
Owners email: (,(7 ' S a •CUyYOIwner s Phoney:
Agent's Name:
Agent Phoner�
M-EC
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Agents Email:
ADJACENT RIPARIAN pRoPER T Y OWMErt'S CERTIFICAT101'
,(Bottom portion to be completed by the Adjacent Property Owner)
1 herebv certify that I own property adjacent to the above referenced property_ The individual applying for this
permit has described to me, as stlown on the attached drawing, the development they are proposing. A
✓ t� I DO NOT have objections to this proposal_ i DO have objections to this proposal.
If you have oblecgons to vahat is fsehig proposers, you must notrfy the AI.C. D:aision of Coastal
"J.ranagement (Z)CM) in wriEing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Efkabeth City, MG, 27909. DCM representatives can also be
contacted at {252} Z&4_350^n_ AD resptnrisa?s considered the same as no ohjc-claon r6 y©er have been
notified by GerWed Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blanl( below_)
100 wish to waive somelail of the 15' setback
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner.
YypedlPrinted name of ARPO:
Mailing Address 1of ARPO: 'lurk
ARPO's email: J 4t��t VY CIn 1®U rn0.l (A!✓t ARPO's Phones;::
Date: 3 -waiver is valid for up to one year from ARPO's Signature
Revised July 2021

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RECEIVED
-4.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIRCATIONMAIVER FORM APR 1 6 2624
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner:
Address of PropedT--
Mailing Address of Ownnel
Owners email:
Agent's Name:
Aoenfs Email:
®CM -EC
t4'-lCl
LOOL1&Pra-d
t r L:M� L 2-P23
II Gt, C lad CDiV)"MO � At Z-PZ3
Q06 Owner's Phone#.
Agent Phone#.
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion fo be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacermto the above referenced property. The individual applying forthis
permit has described to me, as shown on the attached drawing, the development they are proposing. 9
I DO NOT have objections to this proposal- I ADO have objections to this proposal.
if you have objections to witat is being proposed, you must notify the M.C. flivision of Coastal
(Jranagement (OCMJ in wrib`ng within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St, Ste. 300, Elisabeth City, MC, 27909. DCR9 representatives can also be
contacted at (252) 26;73M. Mo tespenss is considered the same as no objection ff you have been
notified by Certified ftiarT.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minrmum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or ripmp revetments). (if you wish to waive the setback, you must sign
the appropriate blank below-)
I DO wish to waive some/all of the 15' setback
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the I & setback require initial the blank)
Signature of Adjacent Riparian Property
Typed/Printed name of ARPO_1 i <t .116J-q t/ I A jj� `K10 I l i !r'
Mailing Address of ARPO: ! q d6 wak Ii, 1�A DID \o ck KIV a-Il d 3
ARPO's email: (f�l Ado) (a �y]yAi) t0 ARPo's Phone#: � �7 - 73q -06 9�i
Date a In(_'waiver is valid for up to one year from ARPO's Signature=
Revised July 2021

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